揭示干针疗法短期效果背后的机制：利用反复测量的中介因素和结果进行中介分析的新见解。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2024-12-01 DOI:10.1016/j.apmr.2024.07.016

Carlos Murillo PhD , Ester Cerezo-Téllez PhD , María Torres-Lacomba PhD , Thien Quy Pham BS , Enrique Lluch PhD , Deborah Falla PhD , Tat-Thang Vo PhD

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引用次数: 0

摘要

目的：探讨深部干针疗法（DDN）对慢性颈部疼痛患者短期疗效的因果关系。设计：利用重复测量的中介因素和结果进行解释性纵向中介分析。环境：初级保健环境。参与者：128名慢性颈部疼痛患者：结果测量：包括两个结果（疼痛强度和颈部疼痛相关残疾）和 3 个候选中介因子（局部疼痛压力阈值 (PPT)、颈部活动范围 (ROM) 和颈部肌肉力量）。疼痛强度还作为竞争中介因子被纳入了残疾中介分析。中介因子和结果在三个时间点进行测量：干预后、2 周和 4 周随访。结果显示：从干预后到四周随访期间，疼痛强度的降低在很大程度上调节了 DDN 对残疾的短期影响。此外，局部超敏反应的减弱（通过 PPTs 的增加）在各时间点对疼痛强度的降低起到了一定的中介作用。另一方面，颈椎活动度的增加有助于减少与颈部疼痛相关的残疾。结论：这项新颖的研究表明，DDN 对颈部疼痛相关残疾的影响主要是由这种物理治疗方法的镇痛效果所驱动的。增加 PPTs 和颈椎 ROM 似乎也是 DDN 效果背后的部分机制。

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Unraveling the Mechanisms Behind the Short-Term Effects of Dry Needling: New Insights From a Mediation Analysis With Repeatedly Measured Mediators and Outcomes

Objective

To explore the causal pathways underlying the short-term effects of deep dry needling (DDN) in people with chronic neck pain.

Design

Explanatory longitudinal mediation analysis with repeatedly measured mediators and outcomes.

Setting

Primary care setting.

Participants

Patients (N=128) with chronic neck pain.

Interventions

Participants were randomized into 2 groups; DDN of the neck muscles combined with stretching (n=64) and stretching alone (n=64).

Main Outcome Measures

Two outcomes (pain intensity and neck pain–related disability) and 3 candidate mediators (local pressure pain thresholds [PPTs], cervical range of motion [ROM], and neck muscle strength) were included. Pain intensity was also included as a competing mediator in the mediation analysis for disability. Mediators and outcomes were measured at 3 time points: after intervention and at 2- and 4-week follow-up. Age, sex, and the baseline values of the outcome and mediators were included as pretreatment mediator-outcome confounders.

Results

Reductions in pain intensity strongly mediated the short-term effects of DDN on disability, from after intervention to 4-week follow-up. In addition, the attenuation of local hypersensitivity (via increasing PPTs) moderately mediated reductions in pain intensity at each time point. On the other hand, gains in cervical ROM contributed to reducing neck pain–related disability. Changes in muscle strength did not lead to better outcomes.

Conclusions

This novel study demonstrated that DDN effect on neck pain–related disability is strongly driven by the analgesic effects of this physical therapy modality. Increasing PPTs and cervical ROM seem to be also part of the mechanisms behind DDN's effect.

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.